Which non-steroidal oral contraceptive pill is initially taken twice a week for the first three months and then once a week thereafter?

1. A

   Levonorgestrel (Postinor)

2. B

   Centchroman (Saheli/Ormeloxifene)

3. C

   Desogestrel (Cerazette)

4. D

   Medroxyprogesterone Acetate

Appeared in: AIIMS CRE 2025

Explanation

• Centchroman, also known as Saheli, is a non-steroidal oral contraceptive pill.
• It is classified as a Selective Estrogen Receptor Modulator (SERM).
• Its unique dosing regimen involves taking the pill twice a week for the first three months, followed by a maintenance dose of once a week.
• This mechanism and schedule make it distinct from hormonal contraceptives.

Why Other Options Were Wrong

• Option A: Levonorgestrel is a steroidal hormone (progestin). It is not taken on a weekly schedule but is used either as an emergency 'morning-after' pill or as a component of daily contraceptive pills.
• Option C: Desogestrel is a steroidal hormone (a third-generation progestin). It is formulated as a progestin-only 'mini-pill' that must be taken daily, not weekly.
• Option D: Medroxyprogesterone Acetate is a steroidal progestin, but it is not an oral pill for weekly use. It is administered as a long-acting intramuscular injection (Depo-Provera) every 3 months.

Related Visual

• Visual 1: Comparison Chart - A chart comparing Centchroman with other hormonal contraceptives (Levonorgestrel, Desogestrel, MPA) based on type (steroidal vs. non-steroidal), administration route (oral, injectable), and dosing frequency (daily, weekly, monthly, quarterly).
• Visual 2: Dosing Calendar - A simple calendar graphic illustrating the dosing schedule for Centchroman: showing two pills per week for the first 12 weeks, then transitioning to one pill per week.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacology of Hormonal and Non-Hormonal Contraceptives as background academic context rather than a clinical decision trigger.
• Patient education is critical for Centchroman. The nurse must clearly explain the initial bi-weekly schedule followed by the weekly maintenance dose to ensure adherence and contraceptive efficacy.
• Centchroman is a valuable option for women who have contraindications to hormonal contraceptives (e.g., history of thromboembolism, estrogen-sensitive cancers) or who experience intolerable side effects from them.
• What if? A patient in her second month of using Centchroman misses one of her two weekly doses. The nurse should advise her to take the missed pill as soon as she remembers, take the next pill on its scheduled day, and use a backup method of contraception (like condoms) for the next 7 days.

How to Approach the Question

• First, analyze the question to identify the key requirements for the correct answer. The keywords here are 'non-steroidal', 'oral contraceptive pill', and the specific dosing schedule 'twice a week... then once a week'.
• Next, evaluate each option against these criteria.
• Eliminate options that are steroidal. Levonorgestrel, Desogestrel, and Medroxyprogesterone Acetate are all steroidal progestins.
• Eliminate options that do not match the administration route or schedule. Medroxyprogesterone is an injection, not an oral pill. Levonorgestrel and Desogestrel are typically taken daily or for emergency use.
• The only option remaining, Centchroman, is known to be a non-steroidal pill with a unique weekly dosing schedule, matching all parts of the question.

Concept Tested & Keywords

• Concept Tested: Pharmacology of Hormonal and Non-Hormonal Contraceptives
• Stem keywords: non-steroidal, oral contraceptive pill, twice a week, once a week
• Lead-in keywords: Which

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